D by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required. Student: Birthdate: Prescription.
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How to fill out the MD MCPS 525-13 online
The MD MCPS 525-13 form is essential for authorizing the administration of prescribed medication to students in Montgomery County schools. This guide provides clear, step-by-step instructions to help you accurately complete the form online.
Follow the steps to effectively complete the MD MCPS 525-13 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part I, enter the student's name and birthdate, and specify the prescription type by choosing either 'Renewal' or 'New'. If it’s a new prescription, note the date when the first full day's dosage was given at home.
- List all current medications the student is taking, including any over-the-counter medications.
- Ensure the parent or guardian signs the form, includes their phone number, and the date of completion in the designated area.
- In Part II, the physician is required to fill in details such as the name and dosage of the medication, administration times, the route of administration, and effective dates.
- Make sure the physician includes their name, signature, phone number, and the date in the specified fields.
- For self-carry/self-administration of emergency medications, ensure the prescriber’s authorization and school nurse approval are documented, along with their signatures and dates.
- In Part III, check the appropriate boxes to confirm that Parts I and II are completed, and record the date when any unused medication should be collected by the parent or guardian.
- Finally, obtain the signature of the principal or school nurse and ensure the date is included.
- Once all sections are filled out accurately, save the changes, and use the options to download, print, or share the completed form as needed.
Complete your MD MCPS 525-13 form online today for efficient medication administration at school.
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